2012 Canada Wellington-Dufferin-Guelph Public Health HPDCD(F)28-2025

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The document is an 'Infectious Disease Risk Assessment Form' for Emergency Service Workers (ESWs) detailing the process for reporting exposure to infectious diseases. It includes sections for general information, exposure details, source information, immune status of the ESW, and post-exposure recommendations. The form aims to collect comprehensive data regarding the nature of the exposure, personal protective equipment used, and follow-up medical advice to ensure the health and safety of ESWs.
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  1. Click ‘Get Form’ to open the 2012 Canada Wellington-Dufferin-Guelph Public Health HPDCD(F)28 in our editor.
  2. Begin by filling out Section A: General Information. Enter the name of the Emergency Service Worker (ESW), date of report, date of birth, work title, home address, and contact details.
  3. Proceed to Section B: Exposure Details. Indicate the body fluids involved in the exposure and describe how it occurred. Be thorough in detailing any personal protective equipment (PPE) used.
  4. In Section C: Source Information, provide information about the source if known, including demographics and risk factors. This section is crucial for assessing potential health risks.
  5. Complete Section D: ESWs Immune Status by checking vaccination statuses and providing dates for any relevant vaccines.
  6. Finally, review Section E: Post Exposure Recommendations. Ensure that all recommendations are noted and discussed with the designated officer before signing off on the form.

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